Splenic Rupture

 

Splenic rupture is a critical condition often occurring after trauma, particularly to the left side of the body, such as in a road traffic accident (RTA). It involves a tear in the spleen, leading to potential internal bleeding.

Clinical Manifestations

i. Pain: Severe pain on the left side of the chest and abdomen, which may radiate to the left shoulder (Kehr’s sign).
ii. Vital Signs: Rapid drop in blood pressure (hypotension) and an increase in heart rate (tachycardia) indicating hypovolemic shock.
iii. Physical Examination: Abdominal tenderness, guarding, and signs of peritonitis in severe cases.

Diagnostic Investigations

i. Abdominal X-ray: May show the absence of the left psoas shadow due to splenic bleeding or fluid accumulation.
ii. Focused Assessment with Sonography for Trauma (FAST): Identifies free fluid in the peritoneal cavity, suggesting internal bleeding.
iii. CT Abdomen: The gold standard for diagnosis, providing a detailed view of the spleen and any associated injuries or bleeding.

Management
i. Splenic Rupture: Once confirmed, requires urgent surgical intervention (splenectomy or splenorrhaphy) to control bleeding and prevent further complications.
ii. Subsplenic Hematoma: Different from a complete rupture; this condition involves blood accumulation within or around the spleen. If the patient is stable, it may be managed conservatively with close observation by a surgical team.

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